Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with vertebral compressive fractures (VCFs) that may occur as a consequence. Vertebral compression fractures (VCFs) can lead to severe acute and chronic pain, impaired mobility, reduced quality of life and an increased risk of mortality due to decreased mobility and pulmonary dysfunction. When painful VCFs do come to clinical attention, they are typically treated with optimal pain management (OPM). Although the natural course of pain due to vertebral fractures decreases within the first weeks in the majority of patients, a number of them remain with persistent pain and/or ongoing vertebral collapse. Facet joint injections are an emerging procedure as possible treatment for a subgroup of patients with persistent pain after VCFs. In case of vertebral collapse or persistent pain after facet joint injections, patients have to be treated with percutaneous vertebroplasty (PVP) or percutaneous balloon kyphoplasty (BKP). PVP is a minimally invasive surgical procedure in which bone cement is injected into a fractured vertebra under radiological guidance using fluoroscopy. BKP is a variation of this approach, in which an inflatable balloon tamp is placed in the collapsed vertebra prior to cement injection, in order to create a cavity allowing low pressure injection. For peo- ple with painful osteoporotic VCFs refractory to analgesic treatment, PVP and BKP perform significantly better in unblinded trials than OPM in terms of improving quality of life and reducing pain and disability. It is possible that BKP and PVP may lead to reductions in mortality. In small subgroup of patients with neurological injury related to an osteoporotic fracture, different open surgical techniques were used to suit different fracture patterns, with good clinical and radiological results.